The surgical value framework in hand surgery: a conceptual model for evaluating surgical pathways

INTRODUCTION: Hand surgery has robust patient-reported outcome measures to assess symptoms, disability and function, but surgical pathways may also differ in how treatment is delivered, experienced, recovered from and resourced. A conceptual model is needed to consider these wider dimensions without assuming that one pathway is superior to another. METHODS: This Further Knowledge article presents the Surgical Value Framework as a practical model applicable to any surgical pathway, including established open procedures, procedure-room care, Wide Awake Local Anaesthesia No Tourniquet (WALANT), arthroscopy and image-guided techniques. RESULTS: The framework evaluates five domains: clinical value, patient experience value, recovery value, economic value and environmental value. Clinical safety and effectiveness remain foundational. The other domains consider how treatment is experienced, how quickly patients return to valued activities, what resources are required and what wider impact is generated. The framework is designed to test, rather than assume, value and may therefore demonstrate additional, equivalent or no additional benefit when established and contemporary pathways are compared. CONCLUSION: The Surgical Value Framework complements rather than replaces established patient-reported outcome measures and complication reporting. By matching outcome measurement to the claims made for a pathway, it provides a more balanced basis for clinical evaluation, research and service design.